PHYSICAL HEALTH

Whatever form your particular regimen takes—a revamped diet, a rigorous exercise program, or some combination thereof—if it really works, you are probably going to hate every minute of it.

“I’m concerned,” said Amy Gorin, a New York-based nutritionist. I had just finished telling her about my efforts to lose weight: 25 pounds in six weeks. She did not approve of my chosen methodology, and she was not alone.

“Wow, that’s a lot of weight in a short period of time,” said Ginger Hultin, a Seattle-based registered dietician and a spokesperson for the Academy of Nutrition and Dietetics.

“Did this all really happen?” asked Rebecca Scritchfield. She’s a nutritionist in D.C., and author of a book called Body Kindness. “It would be rare for me to hear everything you described, and for somebody to come see me and say that they don’t have any problems or concerns whatsoever. That would just not normally happen.”

“I’m definitely not a fan,” Lauren Harris-Pincus, a nutritionist in New Jersey, told me.

What has them so concerned? In part, the pace of my weight loss, sure. But also, the fact that I told them the key to succeeding, for me, was suffering.

Here are some things to know about me: I’m 36, and about six feet tall. I would describe my body type as “skinny, but with a belly.” And I had back surgery in April to fix a herniated disc. For most of my adult life, I’ve fluctuated between 165 and 185 pounds. But when I weighed myself after a physical therapy session and a light workout on Saturday, September 8, I saw I had crept up to 188.

I should pause here to say some very important things. I know 188 is not an unreasonable weight for someone like me. It is, after all, just a number. This is not about how much you “should” weigh, or what you “should” look like. I don’t think those things matter for most people, as long as you’re happy with how you feel. If you are one of those people, you can stop reading right now! You have already found your holy grail.

But I wasn’t happy. I felt unhealthy, and I didn’t like what I saw in the mirror. In my 20s, my beer belly was “cute,” as one ex-girlfriend put it; now, in my late 30s, it was not. Slowly, I stopped wearing clothes that outlined my muscles, which seemed to have melted away from the bones on which they once sat. I realized I hadn’t gone skiing in years—an activity I used to love. Now, I didn’t think I’d be very good at it anymore, and had quietly decided I didn’t want to find out.

For years, my girlfriend and I had started off our days with a smoothie, not as a weight-management strategy but as a quick and reasonably-healthy breakfast on our respective ways out the door: One banana, two dates, a cup of unsweetened coconut almond milk, a scoop of peanut butter, and a fistful of spinach. Nutritionally, it’s a little like eating a salad, but tastes more like drinking dessert. The next day, I went from downing this 500-calorie concoction in the morning—and eating whatever I wanted at all points in between—to having a smoothie for both breakfast and dinner. For lunch, I had a bowl of soup or a small sandwich. No more Thursday morning bagels at work; no more flanks, ribeyes or New York strips; and definitely no snacks.

I felt hungry all the time. I went to bed hungry. I woke up hungry. The only time I wasn’t hungry was after a smoothie, and that fleeting moment of satiety never lasted. The parts of my brain that had once been reserved for “What should I have for dinner?” were now occupied only by hunger and, in a cruel twist, trying not to think about being hungry.

Time slowed to an agonizing, glacial pace. When you eat three square meals and as many snacks as you please, your day unfolds in measurable chunks, none of them more than a few hours. But when your “meals” take only minutes to prepare and consume, passing the time between tiny lunch and liquid dinner starts to feel like filling a pool with a garden hose: You can see the water going in, and you know, intellectually, that the pool level is increasing with each passing minute. But it still isn’t enough to swim, and it seems like it never will be. For the rest of the afternoon, the only thing you can do is stand there, staring at the bottom, thinking about how badly you want to do a cannonball.

Nights were not quite as hard. (A pair of caveats: I didn’t want the routine to get in the way of my social life, so occasional dinners with friends went on as planned. For the same reason, I didn’t give up alcohol, although I’m a light drinker.) I addressed occasional evening stomach rumblings by popping cans of La Croix. Going to sleep hungry felt like an accomplishment—like I was making progress. And in the morning, I felt like I had earned that breakfast smoothie, even though I knew I’d be hungry soon after finishing it. Blend, sleep, repeat.

A weird thing happens when you start drinking most of your food. At first, you miss chewing. After a week, the thought of swallowing any more green sludge was nauseating. The goop had nasty habits of sticking to the side of my Vitamix and dripping onto my counter, highlighting dark-green specks of semi-blended spinach floating in a sea-foam green cloud of health.

Then, the very idea of chewing starts to horrify you. Smoothies are so easy. The thought of laboring through a chopped salad for lunch—my only solid food on most days—started to feel exhausting. On rare dinners out at restaurants, I chose entrées based primarily on how I expected my jaw to feel after all the boring chewing had concluded. A separate horror began to gnaw at me: What if I’ve become incapable of ever enjoying a ribeye again?

​Another caveat: What I’m about to share is not for people who struggle with eating disorders. It’s also not for people who are unable to change their bodies through diet and exercise, whether due to medical reasons, or some other complicating set of circumstances. It is also not for people who don’t want to change their bodies at all. (Again, you have the grail! Good for you.)

For everyone else: If you want to make a meaningful change to your body, there is only one dependable path, and that path is suffering. Whatever form your particular regimen takes—a revamped diet, a rigorous exercise program, or some combination thereof—if it really works, you are probably going to hate every minute of it.

Think about it this way: Why are your habits, well, your habits? Because they are easy to develop, and comfortable to maintain. For me, it required no effort to eat whatever I wanted, whenever I wanted, and it felt comfortable to skip the gym in favor of the latest David Attenborough nature documentary. But when I wanted to change my body, I had to change those habits. That was hard! It’s hard to be hungry when you’d rather be eating; it’s hard to knock out 40 minutes on the bike when you’d rather be watching Planet Earth II on repeat.

There is a lot of money riding on you not believing this is the case. The weight loss industry is a $66 billion business. Half of all Americans say they’re trying to lose weight, and about 45 million of them start diets every year. Most of these efforts, studies show, will fail. Yet for those legions of beleaguered calorie-counters, nearly every nutritionist and weight loss expert I spoke to offered the same reason for hope: It’s easy, in fact, to achieve the results you’re chasing, as long as you carefully follow their method—which, besides being easy, is affordable, too. How convenient!

“No, you don’t have to suffer! Suffering isn’t a necessity,” Trudie German, a certified personal trainer in Canada, assured me. “At some point, you have to stop suffering. Why do you want to keep suffering?“

“I don’t think it’s necessary to suffer,” Liz Arch, a life coach and yoga teacher, told me. “We can put this idea on ourselves that we have to suffer in order to get to whatever grand goal we’re trying to meet, but I don’t think we have to suffer. I think there’s an easier, gentler path."

“I actually think that’s actually the problem with most diets—that people believe they have to suffer to get the results,” said Ayse Durmush, a lifestyle coach and syndicated radio host.

A related reason that humanity’s weight loss hivemind, over time, has not asymptotically approached perfection: Science keeps learning new things about the body, which the industry then packages into a new product for sale to a new cohort of dieters. In reality, any ephemeral consensus about what “works” is less important than whatever message resonates with consumers at that particular moment. In the 1940s, studies linked high-fat diets to high cholesterol levels and heart disease. By the 1960s, low-fat diets were popular. By the 1980s, the medical profession, the food industry, and even the U.S. government were touting the low-fat lifestyle as a proven method of combating the burgeoning obesity epidemic.

Today, we know (or at least we think we know!) more: that some fats are good and other fats are bad. Eggs, dairy, sugar, carbohydrates—practically everything we eat, aside from, say, raw kale—have all gone through similar hero-goat-hero progressions. Even among experts, opinions differ based on the last thing they read, or where they got their certification, or what worked for them once upon a time. “If you talk to 100 people about what kind of diet they recommend, you’ll get 100 different answers,” said weight loss expert Scott Schmaren. (For the record, he believes the true key to success lies somewhere in the manipulation of one’s subconscious.)

What the health and fitness industry is selling, in other words, isn’t your long-term happiness; it’s the latest selection from its collection of programs. And how do you get people to buy in? You promise in the marketing materials that the experience will be fun and comfortable and successful throughout—even though it almost certainly cannot be all those things at once.

When I Google “help me lose weight,” both of the top sponsored results make a similar, sunny pledge. First, an outfit called Sweet Defeat proclaims that its product “makes it easier to live a healthier lifestyle by stopping sugar cravings in seconds.” Perhaps customers of Sweet Defeat have had a different experience, but I’ve never experienced a “craving” for anything that magically disappears without the imposition of a lot of willpower.

The other result is for Noom, a lifestyle startup—think Weight Watchers for millenials—that invites you to start your weight loss journey by filling out a 30-second personal assessment. As I go through the online form, I see what looks like a social media post from an allegedly real person, which has already received several “likes” despite appearing “1 minute ago.” (It is an authentic post, Noom president and co-founder Artem Petakov told me, though he admits the vintage is inaccurate.) “I don’t feel like I’m deprived of any food,” a user named Candace assures me, a prospective customer who hopes to unlock the secrets to her success. “I’m enjoying myself, and my family has noticed my weight loss.”

When I ask about the company’s marketing practices, Petakov says that Noom has studied the best messaging to secure the buy-in of people who will be successful with its program. And the company sent me studies claiming that its methods result in lasting weight loss for more than half its clients. “It’s important not to make it seem too easy, but also important not to scare people off too much,” Petakov explained.

After I answer a few more questions about my height, weight, habits, and lifetime fitness goals, another marketing message pops up on the screen. Its tone is cheerful, almost congratulatory, even though I haven’t done a thing yet: “Sticking to a plan can be hard, but Noom makes it easy”—and for only $32.25 a month.

A few weeks into my adventures with smoothies, I decided to experiment with intermittent fasting: A few days a week, I skipped breakfast and lunch altogether, and ate a normal dinner. The hunger stemming from this layer of my regimen came in intense waves at first, and so I did something many of us do for temporary relief from self-induced anguish: I complained. (Usually over G-Chat, mostly to my now-fiancée, and always in the form of melancholy proclamations that I was not going to make it home alive that night.)

But once my stomach’s growling subsided—perhaps once it realized no relief would be forthcoming—I started to feel great. At the office, it seemed like I could concentrate better, as if an elemental survival instinct had kicked in, and only typing faster and working harder would help me escape danger.

Small reductions in weight can result in large reductions in metabolism, studies have shown, meaning that as you lose weight, it gets harder to lose more weight. I thought I might be able to fight off this phenomenon by walking and biking and going to the gym more often. But a recent study of Biggest Loser contestants indicated that physical activity did not prevent a significant drop in metabolism. It might have helped; it might not have mattered all that much. I don’t know.

Nevertheless, after six weeks of regular fasting, diligent smoothie consumption, and a renewed dedication to scrounging up time in which to stay active, I weighed myself again. 163 pounds. I had thought—or at least hoped—I was making progress, but until this point had resisted the temptation to check, and frankly, I didn’t expect the news to be this good. I felt incredulous and elated at the same time, like (I imagine) how one reacts when they realize all six numbers on the Mega Millions ticket they hold match the sequence on TV. I called my fiancée, and then called her on WhatsApp when she didn’t answer there, and then tried her work number when she didn’t answer there, either, until I finally reached her, breathless, to recount what I had just seen.

This wasn’t only about the number on the scale. My body was trimmer, and I felt lighter and healthier and happy with myself. People were noticing, too. The first person to notice was me, mostly because my pants were falling down. I went out and got two notches added to my belt; I also bought new pants.

Here is the story of Lauren Harris-Pincus, a registered dietician and one of the many skeptical experts with whom I spoke. During her senior year of high school, she went on what she calls a “suffering diet”—a calorie-restriction regimen not unlike the one I went through. “I was so sick and tired of being teased and tortured, and I wanted a new life where I wasn’t heavy. It was a survival instinct,” she said “I grew up in Livingston, New Jersey, and everyone was wealthy and perfect. I’m not a fan of suffering because it steals joy from your life, and I don’t think it’s necessary.”

Harris-Pincus tells me her diet so affected her metabolism that even today, she carefully monitors her calorie intake to maintain the fitness level she wants. It is a telling indictment of her industry’s promises that she accomplished her goals only after deciding that she was willing to suffer—a method she wouldn’t advocate for you, even though it worked for her.

It worked for me, too. After a few weeks of liquid meals and food-free afternoons, I found I had learned to embrace the suffering, because I could see the weight coming off. I derived a real sense of satisfaction in completing my routine, like a machine unaffected by appeals to emotion and/or the allure of microwave pizza. It is the same transformative dynamic I’ve heard described by friends who endured the pain of getting a tattoo; they knew it was a necessary prerequisite to enjoying a long-sought-after reward.

“Diet and exercise are not the key. The key is the picture you have inside of your head—how you see yourself,” Scott Schmaren told me one day. (He’s the subconscious guru, remember.) If weight loss were truly that simple, he would be a billionaire—and to my knowledge, he is not—but he might have a point: When I didn’t want to go to the gym or do that last set of leg lifts, I told myself I was the kind of person who did that last set and squeezed that last rep. There were days when I ate more than I intended, and others when I shortened a workout I should have finished. But I stuck with it, even though everything about the experience, to use a technical term, sucked.

Do the experts think I can keep it up?

“Radical changes in short period of time are possible, but not sustainable,” health coach Aurimas Juodka wrote to me. “It's easy to lose weight putting people on crash diets, but eventually, they’re going to fall back to their old ways.“

“People will get sick of two smoothies a day,“ said Scritchfield.

“Can you sustain that? I would say probably not,” said Sczebel.

As I write these lines, it’s six months since I launched myself into this mostly-smoothie diet. I’ve now lost 36 pounds, down to 152. I’m still eating less than I used to, but I don’t really think about it much. Resisting the mindless, boredom-driven urge to have a snack feels normal; it’s just part of my new routine. And I’m doing things I would have avoided before all this took place. On the first day of our honeymoon in Costa Rica this past winter, I bruised my ribs learning to surf. (It didn’t stop me from surfing for four straight days. Surfing, it turns out, is a lot of fun.)

​My new goal is to put on some muscle. I lift weights now, and I recently bought my first-ever enormous vat of whey protein powder. And when the “suffering” still tests my resolve, I remember those who said I could never lose weight without the benefit of their expertise, and who hustle hard every day to get more customers who will pay to have stevia-sweet nothings whispered in their ears. I smile, and stuff some more spinach—and maybe an extra scoop of protein—into the blender.

Over the past 40 years, doctors have gotten a lot better at treating heart disease. In the 1960s, it wasn’t unusual for adults to die or become severely disabled from heart attacks in only their fifth or sixth decade of life. And while heart disease is still the number-one killer in the United States, it’s also no longer a guaranteed death sentence, thanks to newer medications, improved surgical techniques, and better understanding of the disease.

Society as a whole has also gotten better at preventing heart disease. A 2018 study in the journal Circulation found that the overall rate of heart disease in the U.S. had declined 38% since 1990. Other developed countries have seen even greater reductions.

But these improvements haven’t benefited everyone equally—and one new study shows a troubling trend among young people, and young women, in particular. When researchers looked at hospitalization rates for heart attacks between 1995 and 2014, they found that those numbers had steadily increased among people ages 35 to 54. More specifically, hospitalization rates remained relatively stable among men in this age group but increased significantly (from about 21% to 31%) among women.The findings, published last month in Circulation, aren’t the first to suggest that young women are being left behind when it comes to advancements in heart disease treatment and prevention. Now, doctors are trying to figure out why.

Disturbing heart trends for young women

Scientists can’t say for sure what’s causing an increase in heart disease among young women, but they do have some ideas. Last month’s study found that not only had hospitalization rates for heart attacks increased among young people since 1995, but that hypertension and diabetes rates had increased as well. The young women in the study were also more likely to be black than the young men, suggesting that heart disease is hitting young black women especially hard.

The study didn’t look at patients’ body mass indexes, but co-author Melissa Caughey, PhD, a research instructor at UNC School of Medicine, notes that hypertension and diabetes tend to be associated with obesity.

“We know that there’s an obesity epidemic going on in the United States, and we know that women—especially black women—tend to have higher obesity rates than men,” Caughey tells Health. “It may be that these are actionable areas where physicians could do better to manage risk factors in these high-risk patients.”

Another interesting finding was that, compared to the young men in the study, the young women were less likely to have previously been treated for conditions like high blood pressure, high cholesterol, or stroke. This suggests that women are being under-treated for heart disease risk factors, wrote Viola Vaccarino, MD, PhD, an epidemiologist at Emory University, in a commentary published along with the study. Prevention guidelines may also underestimate risk among this age group, she added.

“Notably, there was no indication that the sex-related treatment gap improved between 1995 and 2014; if anything, there was a tendency for the disparities to worsen over time," wrote Dr. Vaccarino.

Another challenge is that women tend to experience heart attacks differently than men—so they, and their doctors, may not even recognize it when it’s happening, and their treatment may suffer as a result.

“Traditionally, a heart attack is described as the man clutching his chest and suddenly falling out of his chair,” says David Goff, MD, director of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute. “But heart attacks are seldom that dramatic, especially for women.” Women are more likely to report back pain, nausea, sweating, lightheadedness, or dizziness, Dr. Goff tells Health, rather than chest pains.

“When women present with these symptoms, the sad reality is that too often, the health care system doesn’t think about heart attacks first,” he says. “Women might be told that it’s anxiety or it’s gastroesophageal reflux or some other problem, because physicians still don’t know to look for heart problems.”

What needs to change

The new Circulation study did find some promising trends. Young women in the study were less likely to smoke than their male counterparts and were more likely to have health insurance. Indeed, says Dr. Goff, the decline in smoking rates over the last 50 years has been a big part of the overall decline in heart disease across all age groups.

Caughey stresses that the overall risk of heart disease for young women “remains quite low,” and that it increases significantly after menopause. “I don’t think this is anything for young women to panic over, but I do think it’s a warning sign that maybe women of this generation are not as healthy as those of previous generations were.”

Dr. Goff paints a slightly more concerning picture. “One out of four women in our country will die of heart disease, and 60% will have a major cardiovascular event before they die,” he says. “This means that none of us can really ignore our heart health—whether you’re older and overweight or you’re young and lean and otherwise healthy.”

Young women can improve their lifestyle and decrease their risk for heart disease by getting more physical activity, eating a healthier diet, and avoiding both first- and secondhand smoke, says Caughey. “And even if you’re already doing that, you should still know your numbers and check in every year or so with your doctor,” she adds.

Ultimately, experts say, doctors need to watch young women for symptoms of heart disease, so they can be diagnosed and treated before their conditions worsen. Doctors also need to pay attention to risk factors that could make young women more vulnerable to heart attacks and other forms of heart disease in the future.

For example, Dr. Vaccarino wrote, young women who have heart attacks are more likely than men to have depression or post-traumatic stress disorder, to report high levels of stress and more life adversities, and to fall into lower education and income brackets. Female-specific conditions like polycystic ovary syndrome (PCOS), premature menopause, or a history of preeclampsia may also play a role in heart disease risk.

“Younger adults, and women in particular, have been inadequately studied in cardiovascular research,” Dr. Vaccarino wrote. “It is now time to pay attention to this group to optimize prevention strategies and promote cardiovascular health among women.”

For now, Caughey says, it’s up to women to look out for themselves. “It’s probably not something that’s on the radar for a lot of young women,” she says, “but it’s never too early to focus on living a heart-healthy lifestyle.”

Nutrition is an important part of staying healthy and these days good nutrition involves feeding your body nutrients via taking adequate supplements to make up for the pollution and denatured food on our planet. There are many reasons we don’t always get our full supply of nutrition. Sometimes even when we eat well, we find out we are malnourished. It has to do with how much you are actually absorbing from the foods you eat. Also, medication can be responsible for minerals and vitamins being sucked out of our systems at a faster rate than we can absorb them and we end up deficient.

Some medications can interfere with the absorption of the natural nutrients you may think you are getting through your diet. This can then cause health problems that you wouldn’t think would be caused by those medications because they are “supposed” to make you better. It is important to keep a list of all your medications and their dosage in your bag, phone or wallet and the dates you started taking them for emergency situations. This also helps you keep check so you don’t overuse your medication.

It is important to know what your medication is used for and not to just take it blindly. Check with your doctor or pharmacist as to the side effects so if you feel unwell, you can decipher if it’s a result of the medication or you genuinely are unwell. If you use the same pharmacist every time, they will keep track of it for you. Always check to see if medications conflict with each other as this can make you very sick.

Many medications, while treating one part of your illness, can lead to nutrition deficiencies, which cause headaches, cramping, low immunity, depression and can increase the risk of clots and osteoporosis. You may also suffer from such side effects as fatigue, bone weakness, dermatitis, dry skin and acne.

Some everyday medications that can interfere with absorption include tricyclic antidepressants, which affect the levels of vitamin B2 and coenzyme Q10; aspirin, ibuprofen and naproxen. which affect iron, folate, zincand vitamin C; the anti-diabetes drug metformin, which can affect folate, vitamin B12 and coenzyme Q10; and the contraceptive pill, which can affect the levels of B vitamins, vitamin C, magnesium, selenium and zinc.

Antibiotics can also deplete the body of essential nutrients. Penicillin such as amoxicillin can lower potassium absorption, while tetracycline such as doxycycline has an effect on calcium and magnesium. This is why it is important if you are regularly taking medications to at least take a multivitamin every day as these vitamins are not stored in the body and if you don’t get your quota one day, then your body becomes nutrition deficient on that day. Put all the days that you don’t get your quota together and you build up a lot of nutrition deficiencies, which will make you ill.

If we were to sum up allergies with an emoji, it’d be a shrug. We know so little about them, and yet tens of millions of Americans experience allergies of some kind or another throughout their lives. They come. They go. They evolve slowly or shift rapidly. Perhaps the only constant is that they’re becoming more common.

But there is some positive news for allergy sufferers everywhere.

“The only good thing about getting older is that​,​ in many cases, allergies are less prevalent,” says Clifford Bassett, medical director of Allergy & Asthma Care of NY and an allergy specialist at New York University. Changes inside and outside our bodies as we age affect the way we react to potential irritants from ragweed to crab to dogs. Why? Well, that’s a little more complicated, and there’s more than one possible reason that your allergy status just switched.

You outgrew it

​Around 60 to 80 percent of kids with milk and egg allergies outgrow them by age 16. Only 20 percent of kids with peanut allergies do so, and only 14 percent of those allergic to tree nuts. Just 4 or 5 percent outgrow a shellfish allergy.

Why? Unfortunately, the answer is that we mostly have no idea. We know some general associations—the earlier a child has an adverse reaction to food, the more like they are to outgrow it—but scientists don’t yet understand why some kids age out of their reactions and others don’t. We do know that early exposure to small amounts of food allergens, especially peanuts, helps prevent allergies in the first place. But we have no idea how to actively reverse them once they happen. If you get allergies as a kid, you just have to wait and see if your tolerances change in the future.

One of the few things researchers have observed is that there does seem to be a time limit to ridding yourself of childhood allergies—if you haven’t outgrown an allergy by your teens, you’re likely to have it for life.

You’re moving to new places

Allergies, especially the seasonal variety, can change a lot over a lifetime, but it might not have anything to do with your body. Every place you live has its own set of allergens, so moving from one town to the next will likely change your allergies too. Teens moving out of their parents’ houses or adults changing jobs may experience a sudden surge of allergies, or sweet, sneeze-less relief.

It also takes time to become allergic to things. You may not feel a reaction to ragweed during your first summer in Tennessee, but have a full-blown allergy the next. That’s because you became sensitized one year and reacted the next. Similarly, you may visit someone with a dog and seem fine, but sneeze constantly the next time you hang out at their home.

You’re just allergy-prone

Some people are just unlucky. Again, we have no idea why, but clearly a subset of humans have immune systems primed to identify allergens as potential dangers, giving those poor folks a whole host of allergies while others go sneeze-free. People with one allergy are far more likely to develop another, and as far as we can tell there’s no way to avoid that unless you prevent exposure altogether. And since most of us don’t want to live in bubbles, that means allergy-prone folks are likely to suffer the sniffles their whole lives.

This is distinct, however, from atopy. Atopy is a genetic predisposition to acquiring allergies that essentially means that nearly everything you come in contact with allergen-wise will become a full-blown allergy. Getting a dog? You’ll be allergic soon. Moving house? Enjoy the new outdoor allergies. Atopic people are also more likely to have eczema and asthma. Corticosteroids can sometimes help, as can allergy shots, but it’s still often a lifelong affliction.

Your body is changing

The link between hormones and allergies haven’t been well studied, but some small studies and anecdotal evidence suggest that your immune system can shift a bit in response to hormonal changes. Like nearly everything hormone-related, this affects people with menstrual cycles the most. “In women, the effect of hormones​,​ such as estrogen​,​ may lead to ​a ​worsening of their asthma during different​ times of the menstrual cycle,” explains Bassett. Puberty, pregnancy, and menopause are also commonly times of allergic change—at least anecdotally, since few studies on the subject exist in the literature. Asthma symptoms definitely change during these shifts in hormonal balance, and female bodies experience more autoimmune diseases and immune responses generally, which seems to indicate that female sex hormones have a significant influence on the immune system.

Bassett also notes that factors like weight gain and obesity can affect your immune system, leading to less well controlled asthma and other allergy symptoms over time. Older adults also tend to have a drop off in the kind of antibodies that instigate allergic responses, which means they may lose their reaction to a food or pollen that they used to react to powerfully. But simultaneously, lots of seniors seem to lose tolerance to foods like shellfish, even if they’d previously been able to eat crab every single day.

Or maybe we just have no idea!

And finally, let’s give one last big shrug for all the other factors that seem to influence allergies that we don’t understand at all. A significant chunk of our most-pressing allergy questions are simply unknown. Luckily, allergy research is exploding right now, so hopefully we’ll have answers to those irritating questions soon. In the meantime, if you’re suffering from allergies, get personalized help. Allergists can identify your particular issues and will suggest treatment options, all of which (if you can afford it) will help you manage your allergies better.

While chronic kidney disease (CKD) clearly affects a child’s physical health, new research suggests that it can also have a negative impact on neurocognitive function, academic performance and mental health. These effects can result in long-term consequences for children with CKD as they transition into adulthood.

The findings, published in the Clinical Journal of the American Society of Nephrology (CJASN), show that childhood CKD may lead to mild deficits across academic skills, executive function, and visual and verbal memory.

For the analysis, researchers examined all of the published evidence on cognitive and academic outcomes in children and adolescents with CKD. Their analysis included 34 studies involving more than 3,000 CKD patients under the age of 21 years.

The findings suggest that children with CKD tend to have low-average neurocognitive and academic outcomes. The global cognition IQ of children with CKD was classified as low-average. Compared with the general population, the average differences in IQ were as follows: -10.5 for all CKD stages, -9.39 for patients with mild-to-moderate stage CKD, -11.2 for patients who underwent kidney transplantation, and -16.2 for patients on dialysis.

Direct comparisons revealed that children with mild-to-moderate stage CKD and those who received kidney transplants scored 11.2 and 10.1 IQ points higher than those on dialysis.

Children with CKD also had lower scores than the general population in executive function and memory domains, and they scored lower in tests of academic skills related to mathematics, reading, and spelling.

“In translating our findings to clinical practice, this research provides relevant information on the areas of need — for example, working memory and mathematics — for which children with CKD may need guidance, practice and assistance, particularly for children on dialysis,” said Kerry Chen, M.B.B.S., at the Centre for Kidney Research, University of Sydney, in Australia.

“It also suggests hypotheses for why the overall intellectual and educational outcomes of children with CKD are reduced compared with the general population, and how best to prevent deficits.”

In an accompanying Patient Voice editorial in CJASN, Lori Hartwell, Founder and President of the Renal Support Network, who has had kidney disease since two years of age wrote, “I recall occasions while on hemodialysis experiencing poor cognition and difficulty retaining information.”

“It is not surprising that children and adolescents on dialysis are at greater risk of such effects. Studies have shown a decline in cognitive function that has been associated with fluid and solute shifts while undergoing hemodialysis.”

10 Shocking Things about Narcolepsy that the Media Doesn’t MentionNarcolepsy isn’t the snoozefest we imagined. It’s a fascinating neurological disorder with aspects of dream sleep sneaking into daily life in odd ways like experiencing hallucinations and being paralyzed head-to-toe.

Surprised? I was too — when I was diagnosed 8 years ago in law school.

Julie Flygare, JD — founder of Project Sleep and author of “Wide Awake and Dreaming: A Memoir of Narcolepsy”

Hi! I’m Julie Flygare, a writer and yogi living with narcolepsy in Los Angeles. Here are the most shocking things you didn’t know about narcolepsy and the media doesn’t mention:

10.Narcolepsy is not a joke. As a young law student at Boston College, I realized I was having mysterious health issues but — narcolepsy?! “Nooo, that’s just a joke about someone falling asleep standing… I don’t have that!”

Popular films like Rat Race, Deuce Bigalow: Male Gigolo and Moulin Rougefeature comical characters with “narcolepsy” falling asleep mid-sentence while standing. This is not what doctors are looking for to diagnose narcolepsy. Narcolepsy’s sleepiness is often much more invisible and pervasive, and that’s just ONE of five major symptoms. Yet, because of the comedic portrayals, people often laugh when they learn I have narcolepsy, even though I have a serious neurological disorder like epilepsy or Parkinson’s disease.

9.People with narcolepsy do NOT sleep all the time.Individuals with narcolepsy may fight sleepiness during the day but be unable to sleep at night. “Disrupted nighttime sleep” is a major symptom of narcolepsy. Check out this amazing graphic by Falling Asleep.

8.Emotions may cause scary paralysis.Everyday emotions like laughter, surprise or annoyance may cause scary temporary muscle paralysis — jerky knee-buckling, jaw slackening(talking like you’re drunk), head bobbing or collapsing to the ground unable to move for 30 seconds to a minute. This is cataplexy, a very serious symptom affecting 70% of people with narcolepsy.

7.Napping is not a luxury.People with narcolepsy are not “lucky” to take naps, they are experiencing extreme neurological sensations. Napping is often inevitable, unwelcome and difficult to plan for in most school or work settings. I struggle with “nap shame” — feeling embarrassed or weak for napping, even though it’s an essential part of my treatment to be able to work full-time and exercise daily.

6.Narcolepsy involves terrifying hallucinations.Ever woken up but been unable to move your body? This is sleep paralysis, which happens to 1/3rd of all people, but happens more frequently in narcolepsy. Sometimes accompanied by visual, auditory or tactile hallucinations as REAL as reality. This redefines “living a nightmare”.

5.Doctors don’t know narcolepsy.According to a recent study, 91% of primary care doctors and 58% of sleep specialists are NOT COMFORTABLE diagnosing narcolepsy. Only 22% of sleep specialists could name all five major symptoms. As a result, people go undiagnosed for 3 to 25 years. Misdiagnoses include epilepsy, depression, and schizophrenia.

4.Sleepiness doesn’t always LOOK sleepy.Narcolepsy’s sleepiness may manifest as hyperactivity, irritability, moodiness, attention deficits, fogginess, or memory problems. These behavioral and cognitive changes are very real, but not what we think of “sleepiness” — i.e. droopy eyelids, yawning or nodding off.

3.Neurological disorder without a cure.The leading theory is that narcolepsy may be an autoimmune disorder caused by the loss of cells in the brain (called hypocretin or orexin) which help regulate waking, sleeping and dreaming. There is currently NO cure or replacement for the lost neurons. Patients manage with multiple medications and diligent attention to their health and schedules. No two cases of narcolepsy are exactly alike — what works for one patient may not work for another.

2.Sleepiness is NOT laziness.The sleepiness of narcolepsy is neurological and uncontrollable and is not a sign of laziness or lack of will power. Imagine staying awake for 2–3 days straight. That’s how a person with narcolepsy feels daily. If I felt like being lazy, I would watch TV or play games. Sleep is not that fun, I don’t even remember it.

1.You know someone with narcolepsy.Narcolepsy affects 1 in every 2,000 people — 200,000 Americans and 3 million people worldwide, including many children. Narcolepsy is invisible, we may look “healthy” on the outside while fighting internally or behind closed doors. Misperceptions cause many to keep it private. Yet, people with narcolepsy are your friends, neighbors and colleagues.

Loneliness obviously has a powerful role in mental health, triggering symptoms of anxiety and depression when feelings of social isolation take a toll on our emotional wellbeing. The need to surround yourself with loved ones and a fulfilling circle of friends in order to maintain a happy, positive outlook on life is self-explanatory, but what is not often discussed are the potentially damaging effects of loneliness on physical health, as well.

One study published in the British Medical Journal found that feelings of isolation and loneliness in seniors between the ages of 65 and 86 led to a 64 percent increase in the risk of developing dementia, an extraordinary spike in odds highlighting the importance of fostering meaningful relationships at all stages of life. An additional study published in JAMA Internal Medicine reported that seniors experiencing strong feelings of loneliness felt debilitated in their everyday lives, resulting in trouble completing routine activities like bathing, getting dressed, walking and climbing stairs.

A 2013 study from the AARP reports that 40 percent of adults report frequent overwhelming sensations of loneliness, a number that has doubled from 20 percent in the 1980s. “Social isolation is a growing epidemic — one that’s increasingly recognized as having dire physical, mental and emotional consequences,” Dr. Dhruv Khullar, physician at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, wrote for The New York Times last year.

Contrary to popular belief, feeling lonely isn’t always a result of social isolation. Sometimes, it can be a physical symptom beyond our control. Researchers at Brigham Young University published a literature review this year detailing the complex relationship between loneliness and cardiovascular issues like coronary heart disease and stroke. They determined that social isolation increases the risk of cardiovascular disease and that the government and the medical community need to do more about it. “Given projected increases in levels of social isolation and loneliness in Europe and North America, medical science needs to squarely address the ramifications for physical health,” concluded the analysis.

New research is telling is that preventing loneliness is a critical component to staying healthy, much like eating right, exercising, and steering clear of vices like tobacco, drugs, and too much alcohol. The silver lining among all this rather depressing information regarding loneliness and physical health is that making time to be social isn’t just a weekend and after-work indulgence—it’s an essential investment in our overall health.

A new study published in Biological Psychology sheds light on the neurobiological processes that link stress to cravings for cocaine.

“Despite intensive research efforts, drug addiction persists as one of society’s most significant health-related issues, and treatment options are limited,” explained study author John R. Mantsch, the chair of the Biomedical Sciences Department at Marquette University.

“The development of interventions aimed at relapse prevention is particularly important for improved outcomes in patients with substance use disorders. Much evidence suggests that stress is a critical contributor to drug use and relapse. While it is clear that there is a relationship between stress and drug seeking, the exact nature of this relationship and the underlying mechanisms are unclear.”

“The goals of this study were to develop a new model for studying the contribution of stress to drug seeking and to examine the mechanisms in the prefrontal cortex through which stressful stimuli promote drug seeking,” Mantsch said.

Previous research has established a link between stress and drug cravings, and some studies indicate that stress can act as trigger for cravings.

The findings from new study, which was conducted on rats, suggests that stress can set the stage for — but not necessarily directly trigger — cocaine-seeking behavior. Stress appears to set the stage for cravings through its actions on the medial prefrontal cortex, an area of the brain that plays a major role in executive functions such as planning.

“Clinical reports suggest that, rather than directly driving cocaine use, stress may create a biological context within which other triggers for drug use become more potent,” Mantsch told PsyPost.

“In this paper, we use a preclinical rodent model to demonstrate that, during periods of stress, elevated glucocorticoids mobilize endocannabinoid signaling in the prelimbic prefrontal cortex to attenuate inhibitory transmission and promote cocaine seeking behavior.”

“Our findings establish a novel mechanism through which stress can promote susceptibility to relapse in individuals with substance use disorder and therefore may reveal opportunities for new and more effective treatment strategies aimed at relapse prevention,” Mantsch explained.

But there is still much that scientists don’t understand about the link between stress and drug abuse.

“There are several important questions yet to be addressed,” Mantsch told PsyPost. “First, the time-course of stress effects is suggestive of a glucocorticoid mechanism that this not mediated by the canonical glucocorticoid receptor, which typically functions by regulating gene transcription, resulting in effects that take time to develop.”

​“Secondly, the output pathway from the prefrontal cortex that is regulated by stress and mediates drug seeking needs to be confirmed. Third, it is unclear if the effects of endocannabinoids on drug seeking can be reproduced by cannabis exposure. Such an observation could suggest that acute cannabis use can promote relapse.”

“However, it should be noted that in contrast to cannabis effects which will be exerted throughout the brain, the effects of stress on endocannabinoids are likely not uniform throughout the brain,” Mantsch said. “Moreover, THC (the primarily active cannabinoid constituent in cannabis products) and endocannabinoids have different actions at receptors that may predict distinct effects on cortical signaling and behavior.”

“Finally, we are in the process of determining if there are sex differences in the effects of stress and glucocorticoids on relapse susceptibility.”

​If the embarrassment of talking to your doctor about impotence has kept you from getting a prescription for Viagra, you may be in luck—if you live in the United Kingdom. Regulators there have decided the little blue pill can be sold over the counter, without a prescription, to men 18 and older. Pfizer, the drug’s manufacturer, hopes to have 50mg tablets on shelves by the spring.

The UK regulatory body that made the change, the Medicines and Healthcare products Regulatory Agency (MHRA), said it did so in part to discourage men from buying pills from unregulated online merchants. On the site for Viagra, Pfizer warns that it’s “one of the most counterfeited drugs in the world,” which seems plausible to anyone who’s ever waded through the quagmire of boner pill solicitations in their spam folder.

Fake viagra can contain harmful ingredients—Pfizer says it’s found pills containing blue printer ink, amphetamines (you know, speed), and metronidazole, an antibiotic that can cause an allergic reaction, diarrhea, or vomiting instead of making you tumescent.

"Erectile dysfunction can be a debilitating condition,” Mick Foy, MHRA's group manager in vigilance and risk management of medicines, told the BBC, “so it's important men feel they have fast access to quality and legitimate care, and do not feel they need to turn to counterfeit online supplies which could have potentially serious side-effects.” (Sildenafil, the active ingredient in Viagra, is already available free of charge through the UK’s National Health Service.)

Of course, not every bootleg blue pill contains printer ink, speed, and drywall, and it’s worth drawing a distinction between dangerous fakes and knock-offs that are more threatening to Big Pharma’s profits than they are to public health. (Reuters reports that sales of Viagra have declined since 2012 as Pfizer's patents expired.) The fake drug industry is the shadow side of the above-ground, regulated industry, and by many accounts it’s becoming increasing difficult to police. On any one of the tens of thousands of fly-by-night pharmacy websites, a counterfeit (but perfectly safe and effective) Viagra might be indistinguishable from one that’s potentially harmful. As an eager consumer, you can’t know.

The MHRA wants to steer men away from such sites and toward their neighborhood pharmacist, who will decide whether Viagra is appropriate for each patient who inquires. They can offer advice on whether and how it should be used, and nudge people toward their doctor when necessary. People with liver failure, severe kidney failure, or who have severe heart disease or are at a high risk of cardiovascular disease, or take certain medicines that could interact with Viagra shouldn’t take the blue pull, and it’ll be up to pharmacists to mediate with patients.

That has some pharmacists concerned. Before making its decision, the MHRA had 47 responses to its public comment period; 33 supported making Viagra available over the counter, while one was “unsure.” Among the 13 who didn’t support the plan were eight pharmacists, some of whom were concerned about abuse and misuse of the drug, or that patients might withhold health information in order to get it. The MHRA decided the benefits outweighed those risks.

All of which is well and good, but also academic if you’re living outside the UK, in places where Viagra still requires a prescription. Tonic reached out to Pfizer to see if the company plans to push for over-the-counter status in other countries. The response was not exactly illuminating. “While we do not have information to share on specific Rx to OTC switch programs in the United States, generally we consider prescription drugs—both within the Pfizer portfolio and outside it—for potential switch to non-prescription status,” a Pfizer spokesperson said in an emailed statement. “Our objective is to provide consumers with significantly greater access to medicines with well-established efficacy and safety profiles without a prescription.” And, again, Viagra sales are down globally.

So if you’re a guy in the US waiting for Viagra to be available without a prescription, seems like there’s a sliver of hope. But in the meantime, why not trust your doctor?

A research project that began 20 years ago with an interest in how lithium treats mood disorders has yielded insights into the progression of blood cancers such as leukemia. The research, which centers on a protein called GSK-3, will be published in the Nov. 3 issue of the Journal of Biological Chemistry.

Lithium is considered a highly effective treatment for bipolar disorder and other mood disorders, but it still works in only a fraction of patients and has a number of side effects. Furthermore, its mechanism of action is poorly understood, hampering efforts to improve on it.

In 1996, Peter Klein of the University of Pennsylvania discovered that one of lithium's biological activities was inhibiting GSK-3, an enzyme that modifies other proteins by attaching phosphate molecules, a process called phosphorylation. Lithium's effect on GSK-3 affected the development of animal cells, but it is still unknown what connection, if any, this has to psychiatric disease.

Since then, Klein -- now a professor of medicine at the University of Pennsylvania -- has been investigating many different aspects of GSK-3 activity. "In this paper, we were trying to find out what proteins in the cell are affected by GSK-3 inhibition," Klein said. "We compared cells with GSK-3 to cells completely lacking GSK-3 to ask how other proteins changed."

"Mood disorders are so multifaceted in terms of the pathways and pathologies involved; it's really difficult to pin down a specific pathway," said Mansi Shinde, a former graduate student in Klein's research group who led the new study. "We said: Let's look at what GSK-3 does, and that would maybe lead us toward what lithium does."

The research team used mass spectrometry to compare phosphorylation of proteins from mouse embryonic stem cells with fully functioning GSK-3 to cells in which the gene encoding GSK-3 had been deleted. The resulting massive dataset is called a phosphoproteome -- a comprehensive catalog of proteins that are phosphorylated by GSK-3. Analyzing the data yielded some surprising findings.

Conventional wisdom had suggested that GSK-3 phosphorylates proteins that contain a specific amino acid sequence, but the new phosphoproteome showed that the majority of proteins whose phosphorylation depended on GSK-3 did not contain this sequence. Notably, the phosphorylated proteins included a group called splicing factors, which splice together different sections of messenger RNA, changing the proteins that they encode. Absence of GSK-3 changed the splicing patterns of more than 200 messenger RNAs.

The finding that GSK-3 could affect RNA splicing pointed to an unexpected connection: leukemia. Several factors newly discovered to be phosphorylated by GSK-3 are also known to be mutated in acute myeloid leukemia, a condition in which aberrant splicing causes uncontrolled white blood cell proliferation. This observation could also explain why one of the side effects of taking lithium is increased white blood cell count.

"The effect on the splicing factors and other mutations associated with leukemia was completely surprising to me," Klein said. The group is therefore now pursuing investigations into how GSK-3 affects the growth of healthy and leukemic blood cells.

Shinde and Klein are not yet sure whether GSK-3's effect on RNA splicing explains its role in mood disorders. The effect of GSK-3 on messenger RNA in neuronal cells, with or without lithium, would need to be examined to determine this. The study underlines how investigations into the basic biological function of a drug target can lead in unexpected directions. "[The GSK-3 phosphoproteome] is a really large data set," Shinde said. "It's a resource for the field." "The relevance to leukemia could be direct and something worthy of immediate study," Klein said. "The role in psychiatric disorders is a major interest of the work, but the impact would be down the road, not immediate."

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